Additional Information

Are you currently affiliated with any response organization or volunteer group?

Coast Guard Auxiliary

Red Cross

Salvation Army

United Way

Other

If other, what group are you affiliated with?

List any other relevant certifications:

Certification Type

Agency

Expiration Date

Certification Type

Agency

Expiration Date

Certification Type

Agency

Expiration Date

Have you completed any of the following trainings?

First Aid Training

Yes

No

Certification Type (Basic, Intermediate, Advanced)

Authorizing Agency

Date of Last Training

ICS Training

Yes

No

Courses

Agency

Expiration Date

Coast Guard Licenses

Yes

No

License Type

Agency

Expiration Date

Licensed Amateur Radio Operator

Yes

No

Call Sign

Do you have any other relevant disaster training or experience?

List any other relevant licenses.

Knowledge of languages other then English.

Creole

French

Spanish

Other

If other, what other languages do you speak?

Do you own a boat?

Yes

No

Boat Size

Are You Interested in Volunteering for:

Check yes or no for each of the following.

Pet Shelter Manager

Yes

No

Shelter Manager

Yes

No

Damage Assessment

Yes

No

Health Care

Yes

No

Sign Language

Yes

No

Spanish Translator

Yes

No

Recovery (Hurricanes, Tornadoes, etc.)

Yes

No

Recovery (Oil Spill, Environmental, etc.)

Yes

No

Ham Radio

Yes

No

Attach any certifications, licenses or documents of interest.

Volunteer Liability Wavier Agreement

I understand that I am volunteering my services, that I am responsible for my own actions and hereby waive any liability for any injury to myself or any of my property which I may have at the volunteer site. I further covenant and agree to indemnify and hold harmless Monroe County Board of County Commissioners from any and all claims for bodily injury (including death), personal injury, and property damage (including property owned by Monroe County) and any other losses, damages, and expenses (including attorney’s fees) which rise out of, in connection with, or by reason of the above-referenced volunteer activity.